Joint Circular No. 5-TT/LB provides guidance on the implementation of medical examination and treatment policies for war invalids, those injured and entitled to benefits equivalent to war invalids, retired military officers, workers, and civil servants due to loss of working capacity.

CIRCULAR

 JOINT MINISTRY OF HEALTH - MINISTRY OF HOME AFFAIRS - MINISTRY OF FINANCE DECREE NO. 5-TT/LB
 FEBRUARY 7, 1975 GUIDELINES FOR IMPLEMENTATION OF REGIME
 MEDICAL EXAMINATION AND TREATMENT FOR VETERANS, PERSONS INJURED WHO ENJOY THE SAME POLICY AS VETERANS, DISABLED SOLDIERS, AND OFFICIALS, WORKERS, CIVIL SERVANTS, MILITARY PERSONNEL RETIRED OR STOPPED WORKING DUE TO LOSS OF LABOR CAPACITY
 The Council of Ministers has stipulated the medical examination and treatment regime for veterans and disabled soldiers in Resolution No. 3524-NC dated October 17, 1961, and other documents; and in Directive No. 84-TTg dated August 25, 1963, it has stipulated the medical examination and treatment regime for workers, civil servants, and military personnel retired or stopped working due to loss of labor capacity.
Based on the provisions of the Council of Ministers, the Joint Ministry of Health - Home Affairs - Finance issued Circular No. 19-TT/LB dated March 19, 1962, and Circular No. 25-TT/LB dated August 12, 1969, providing detailed guidance on the medical examination and treatment regime for the aforementioned subjects.
 On April 25, 1974, the Prime Minister issued Decision No. 91-TTg regarding the organization of medical examination and treatment and setting the level of medical fees for state workers, civil servants, veterans, and state workers, civil servants, and military personnel retired or stopped working due to loss of labor capacity. The Joint Ministry of Health - Finance issued Circular No. 32-TT/LB dated December 24, 1974, guiding the implementation of the above resolution. 

Specifically, regarding the medical examination and treatment and management, utilization of funds for this purpose for veterans, persons injured who enjoy the same policy as veterans, disabled soldiers, and officials, workers, civil servants, military personnel retired or stopped working due to loss of labor capacity, the Joint Ministry of Health - Home Affairs - Finance provides additional guidance as follows:

I. SUBJECTS ENTITLED TO THE REGIME OF MEDICAL EXAMINATION AND TREATMENT LIKE STATE WORKERS AND CIVIL SERVANTS AT POST

1. Veterans (who have been classified with disability and granted monthly allowance certificates);  2. Persons injured who enjoy the same policy as veterans (who have been classified with disability and granted monthly allowance certificates);

3. Officials, workers, and civil servants, military personnel who have retired and are receiving monthly retirement or disability allowances;  4. Military personnel with a loss of labor capacity of 60% or more who have returned home and are currently receiving monthly allowances according to Decree No. 500-ND/LB of the Joint Ministry of Social Relief - Finance - National Defense dated November 12, 1958 or Decree No. 523-TTg of the Prime Minister dated December 6, 1958;

5. Disabled soldiers and discharged military personnel suffering from old wounds or diseases that have recurred during their service period (who have been certified by their former units with discharge certificates, injury or illness certificates).

Attached to this Circular is a summary of specific regimes concerning medical examination and treatment for the aforementioned subjects.

II. PROVISIONS ON THE ORGANIZATION OF MEDICAL EXAMINATION AND TREATMENT

- For the aforementioned subjects residing in localities.

A. PROVISIONS ON THE ORGANIZATION OF MEDICAL EXAMINATION AND TREATMENT AND MANAGEMENT OF THE 24-DONG MEDICAL FEE ALLOCATION:

1. Treatment Line:

a) The aforementioned subjects residing in which locality shall be examined and treated at the healthcare facility in that locality when they fall ill.

b) Patients shall visit hospitals at the district, town, city, or area level upon referral from the health station in their commune or small district; they shall visit provincial or city hospitals or specialized hospitals upon referral from the hospital outpatient department at the district, town, city, or area level; they shall visit central hospitals upon referral from provincial or city hospitals. 

When visiting for medical examination, patients must bring along:

- Referral letter from healthcare,
- Health record book,

- Veteran allowance book or retirement allowance book, disability allowance book, discharge certificate of military personnel...

Those suffering from pulmonary tuberculosis, leprosy, or mental illness, in addition to the health record book, shall also carry an outpatient treatment record book issued by specialized hospitals for convenience in issuing medication and monitoring treatment (the Ministry of Health will provide separate guidance on the format of the health record book for the aforementioned subjects).

c) Some exceptional cases:

- In case of emergency, patients among the aforementioned subjects shall be taken to the nearest hospital (including district, provincial hospitals, or central hospitals). The hospital shall fulfill all prescribed regimes as if the patient were under its own jurisdiction.

- If the patient is a retired official or worker with disability living in a locality within the jurisdiction of the Vietnam-Soviet Hospital, when they fall ill, they shall visit the outpatient department of the district, town, or city hospital where they reside for medical examination and treatment. If the condition exceeds the diagnostic and treatment capabilities of the district, town, or city level, they shall be referred to the provincial or city hospital; if it still exceeds the capabilities of the provincial or city level, they shall be referred to the Vietnam-Soviet Hospital. For those belonging to central agencies residing in Hanoi, they shall visit the Vietnam-Soviet Hospital's outpatient department for medical examination and treatment.

2. Provisions on the management and utilization of the 24-dong fund:

a) Commune health stations, small district health stations:

Commune health stations, small district health stations are responsible for managing the health of and providing routine medical examination and treatment for the aforementioned subjects. These health stations shall establish a separate medicine cabinet funded by the district hospital or health office (in areas without hospitals) at a standard rate of 6 dong per person per year (within the 24-dong medical fee allocation). Medication dispensed locally shall not be recorded on prescriptions for patients; commune health stations shall not manage subjects entitled to medical examination and treatment according to the Vietnam-Soviet Hospital standards (except for communes far from district hospitals).

b) Outpatient departments of district, town, city, or area hospitals:

1. Outpatient departments of district, town, city, or area hospitals are responsible for managing and utilizing the 18-dong fund per person per year (within the 24-dong medical fee allocation). This fund is used for treating the aforementioned subjects when they suffer from acute illnesses that do not require hospitalization, gynecological diseases, certain chronic diseases not specified in Circular No. 32-TT/LB dated December 24, 1974 of the Joint Ministry of Health - Finance, and social diseases, chronic diseases specified in the aforementioned joint ministry circular but not yet clearly diagnosed clinically and paraclinically.

- If the patient is a retired cadre or a person with reduced work capacity who meets the criteria for residence at the Vietnam-Soviet Friendship Hospital in their locality, when they fall ill, they shall go to the outpatient department of the district hospital, ward, or city where they reside for diagnosis and treatment. In cases where the diagnostic and treatment capabilities of the district, ward, or city level are exceeded, they shall be referred to the outpatient department of the provincial or municipal hospital; if the provincial or municipal level's capabilities are also exceeded, they shall be referred to the Vietnam-Soviet Friendship Hospital. Specifically, individuals from central agencies residing in Hanoi shall visit the outpatient department of the Vietnam-Soviet Friendship Hospital for diagnosis and treatment.

2. Management and use of funds amounting to 24 units:

a) Health stations in communes and small administrative units:

The health station in the commune or small administrative unit is responsible for managing the health and providing routine medical examinations and treatments for the aforementioned subjects. The health station in the commune or small administrative unit shall establish a separate medicine cabinet funded according to a standard of 6 units per person per year (within the pharmaceutical fee quota of 24 units) by the district hospital, ward, or health office (in areas without a district hospital). Medicines distributed locally shall not be prescribed on prescriptions for patients; the health station in the commune or small administrative unit does not manage subjects eligible for examination and treatment under the standards of the Vietnam-Soviet Friendship Hospital (except for communes located far from the district hospital).

b) Outpatient departments of district hospitals, wards, cities, and regions:

1. The outpatient departments of district hospitals, wards, cities, and regions are responsible for managing and using the sum of 18 units per person per year (within the pharmaceutical fee quota of 24 units). This fund is used to treat the aforementioned subjects when they suffer from acute diseases that do not require hospitalization, gynecological diseases, certain chronic diseases not specified in Circular No. 32-TT/LB dated December 24, 1974 issued by the Ministry of Health and the Ministry of Finance, and social diseases, chronic diseases specified in the aforementioned joint circular but not yet clearly diagnosed clinically and paraclinically.

After completing the medical examination, patients are immediately provided with medication at the site, without monetary compensation, and are not supplied with expensive tonic wines, various types of gelatinous extracts, ginseng, deer antler, cinnamon, bee products such as royal jelly and honey, etc.

In cases where diagnosis and treatment exceed the capacity of district, town, ward, or area clinics, patients shall be referred to higher-level clinics (in accordance with the treatment levels specified in point 1, part A).

2. District, town, ward, and area hospital outpatient clinics also have the responsibility to manage and utilize the entire 24-dong medical and pharmaceutical fee quota for expenditures on common rice, gynecological medications, and outpatient clinic medications for individuals entitled to the Vietnam-Soviet standard outpatient care and treatment benefits currently residing in the locality.

c) Provincial, city, and central hospital outpatient clinics:

Provincial, city, and central hospital outpatient clinics are responsible for conducting medical examinations and confirming diagnoses according to the protocols issued in the locality for lower-tier facilities.

 B. REGULATIONS ON OUTPATIENT TREATMENT FOR SOCIAL DISEASES AND CHRONIC CONDITIONS AT HOSPITAL OUTPATIENT CLINICS:

Outpatient treatment for social diseases and chronic conditions at hospital outpatient clinics for the aforementioned groups shall be implemented in accordance with Circular No. 32-TT/LB dated December 24, 1974, issued by the Ministry of Health and Finance for state workers and officials. The costs for treating social diseases and chronic conditions are stipulated outside the aforementioned 24-dong medical and pharmaceutical fee quota.

C. REGULATIONS ON INPATIENT TREATMENT AT HOSPITALS: 

a) Patients suffering from severe illness who are referred to county, provincial, city hospitals, specialized hospitals within the province or city, or central institutes and hospitals must create favorable conditions for their medical examination and admission for treatment at these hospitals, including war veterans with wounds or old illnesses that recur during service.

b) For those with mental illness who are referred to provincial hospitals or central psychiatric hospitals, if the hospital does not have the capacity to admit them, doctors and medical staff must conduct thorough examinations and diagnoses, and guide lower-tier hospitals on treatment methods. Specifically, for war veterans, they should be referred to the Veterans Affairs Departments of cities and provinces to arrange for them to receive current disability benefits for mentally ill war veterans residing in the locality.

- For the aforementioned groups residing in other areas.

1. War veterans and those injured who enjoy policies similar to those of war veterans, if they are state workers or officials: apply the same regulations as for state workers and officials.

2. War veterans and those injured who enjoy policies similar to those of war veterans and are studying at universities, vocational high schools, and other specialized institutions: follow the regulations applicable to cadres, workers, and officials working at educational institutions.

3. Those who have retired or stopped working due to loss of labor capacity and reside in central and local state farms: follow the regulations applicable to workers and officials currently working and producing at state farms.

4. For war veterans and disabled veterans residing in veteran rehabilitation centers and those who have retired or lost their labor capacity in such centers: the Ministries will separately establish medical and pharmaceutical fee quotas and organize medical examinations and treatments suitable for the health conditions of these groups. Until new regulations are established, the current medical examination, treatment, and medical fee quotas for these groups will continue to be applied, but must be carried out correctly.

III. PROVISIONS ON THE ESTIMATION AND PAYMENT OF VARIOUS TYPES OF EXPENSES 

When visiting for medical examination, patients must bring along:

1. Quarterly and annually, the Departments of Veterans' Affairs and Social Welfare are responsible for informing the Departments of Health and Finance about the number of the aforementioned individuals (current numbers and expected arrivals).

For former military personnel returning to their hometowns with injuries or old illnesses that recur during service, the number should be estimated based on the number treated in the previous year.

2. The Departments of Health base their budget estimates on the number of the aforementioned individuals reported, setting aside an average annual medical and pharmaceutical fee quota of 24 dong per person. Once the estimates are completed, the Departments of Health, together with the Departments of Veterans' Affairs and Social Welfare and Finance, submit them for review and approval by the Provincial People's Committee.

3. The Departments of Finance allocate the approved budget amounts promptly to the Departments of Health based on the decisions made by the Provincial People's Committee.

4. The Departments of Health are responsible for distributing this budget to district, town, ward, and area hospital outpatient clinics or health rooms (where there are no hospitals) according to the actual number of the aforementioned individuals residing in the locality.

5. The Departments of Veterans' Affairs and Social Welfare at the district, town, and ward level are responsible for informing the hospital outpatient clinics or health rooms (where there are no hospitals) about the number of the aforementioned individuals residing in each commune or small administrative unit so that the average annual medical and pharmaceutical fee quota of 24 dong per person can be allocated accordingly. For individuals receiving outpatient care and treatment according to the Vietnam-Soviet standard who have returned to the locality, a budget of 24 dong per person per year is reserved (excluding communes far from the district).

- 6 dong per person per year for commune or small administrative unit health stations to fulfill their prescribed functions as stated in point 2, section B, part II above.

- 18 dong per person per year for district, town, ward, and area hospital outpatient clinics or health rooms (where there are no hospitals) to fulfill their prescribed functions as stated in point 3, section B, part II above. For individuals receiving outpatient care and treatment according to the Vietnam-Soviet standard who have returned to the locality, a budget of 24 dong per person per year is reserved (excluding communes far from the district).

The aforementioned 24-dong medical and pharmaceutical fee quota is covered by the local government budget and directly managed by the health sector.

7. Quarterly and annually, the health sector settles accounts with the finance sector based on actual expenditures according to the actual number of individuals.

8. Expenses for transportation, accommodation allowances, and subsidies for the aforementioned individuals when seeking medical treatment (including both outpatient and inpatient care), subsidies for mentally ill war veterans residing in the locality, and funeral subsidies are all handled by the Veterans' Affairs and Social Welfare sector.

Each year, the Departments of War Invalids and Social Affairs shall prepare budget estimates for the aforementioned expenditures to submit to the Administrative Committee for review and approval.

- For the aforementioned groups residing in other areas.

1. For facilities housing the aforementioned subjects where the costs are covered by the central government budget (universities, specialized secondary schools, and other specialized vocational schools directly managed by the central government with war invalids and disabled veterans currently enrolled), if such facilities are located in a local area, they must allocate 24 dong per person per year into the local budget to be eligible for drug distribution and medical examinations and treatments equivalent to those provided to state employees. However, the funds for outpatient treatment will be subsidized by the central government budget to the local budget.

2. For facilities housing the aforementioned subjects where the costs are covered by the local government budget (including residents of forestry, agricultural, and industrial enterprises), the budget estimate for medical and pharmaceutical expenses at 24 dong per person per year shall be prepared according to Circular No. 32-TT/LB dated December 24, 1974, issued by the Ministry of Health and Finance.

IV. RESPONSIBILITIES OF THE VARIOUS LEVELS AND SECTORS

 To assist the local administrative committees in leading and organizing the implementation of medical examination and treatment services for the aforementioned subjects, the Departments of Health, War Invalids and Social Affairs, and Finance need to closely coordinate to guide their respective vertical sectors to fully implement the provisions of this circular in accordance with their functions and responsibilities as follows:

1. Health: Managing health conditions, implementing medical examination and treatment activities; managing pharmaceutical expenses and allowances for the aforementioned subjects.

To fulfill these tasks, it is necessary to ensure that doctors and medical staff directly involved in medical examinations and treatments thoroughly understand the Party's and Government's policies and the medical examination and treatment systems for the aforementioned subjects, thereby enhancing their sense of responsibility in service provision.

2. War Invalids and Social Affairs: Keeping track of the number of the aforementioned subjects to provide data for healthcare agencies to prepare quarterly and annual budgets. Additionally, the War Invalids and Social Affairs agency needs to closely cooperate with healthcare and finance agencies to inspect, urge, and draw lessons from the implementation of the system; disseminate the medical examination and treatment system among the aforementioned subjects to contribute to its proper implementation.

3. Finance: Providing guidance and assistance to healthcare and War Invalids and Social Affairs agencies in managing the specified budgetary items; approving timely and full disbursement of funds as stipulated herein, while coordinating with healthcare and War Invalids and Social Affairs agencies to monitor the use of funds to ensure compliance with policy and regulations, and prevent embezzlement and waste.

Medical examination and treatment work is a crucial component of the Party and Government's policy towards war invalids, disabled veterans, individuals injured and entitled to benefits similar to war invalids, cadres, workers, civil servants, and retired military personnel due to loss of labor capacity. The Joint Ministries request all levels and sectors to further strengthen leadership and direction in this work.

The medical examination and treatment for families of martyrs and families of war invalids with severe disabilities shall continue to be implemented according to current regulations.